Purpose To explore ultrasonic characteristics of complex fibroadenoma (CF) of breast and its differential diagnosis from invasive ductal carcinoma (IDC).Materials and Methods Sixty-one patients with CF and 81 patients with IDC from January 2010 to February 2016 in the Affiliated Union Hospital of Fujian Medical University were enrolled,and the CF and IDC were confirmed by pathology after operation.The preoperative sonographic findings of CF and IDC were retrospectively analyzed and compared.Results Fifty-nine cases with CF were detected by ultrasonography in 61 cases.Ultrasonic findings of 59 cases of CF showed as follows:79.7％ (47/59) of the CF cases with an aspect ratio ＜0.7;79.7％ (47/59) with blood flow signal of 0 to 1 level;72.9％ (43/59) with liquid dark area,including 67.8％ (40/59) with round or oval cystic fluid area showing local sievelike or diffused distribution;72.9％ (43/59) with irregular shape;61.0％ (36/59) with obscure boundary;61.0％ (36/59) with the largest diameter of tumor ＜2 cm;59.3％ (35/59) with calcifications,including 33.9％ (20/59) with coarse calcification,25.4％ (15/59) with microcalcification and 85.7％ (30/35) with distribution of calcified lesions along the linear high echo zone;54.2％ (32/59) with echo heterogenicity showing linear high echo and high echo in the middle and low echo.There were significant differences in the detection rates of internal regular fluid area,internal linear high echo or high echo area,and alcification distribution along the linear high echo between CF and IDC lesions (all P＜0.01).Compared with IDC,there were higher rates in CF for detecting lesions of largest diameter of tumor ＜2 cm,more regular shape,more clear border,poorer blood flow signal (P＜0.05),but there were lower rates in CF for detecting axillary lymph node enlargement,lesions with edge or spiculation and hyperechoic halo (P＜0.01).Conclusion Color Doppler ultrasonography is of great value in the diagnosis of CF and its differential diagnosis from IDC.

Objective To explore the atypical ultrasonic appearances of breast fibroadenoma and analyze the cause of mis diagnosis.Methods A total of 493 lesions in 485 patients of breast fibroadenoma detected by ultrasound examination andconfirmed by pathology were retrospectively analyzed.Atypical appearances were analyzed and misdiagnosis rate were cal-culated.Statistical methods were taken to compare the misdiagnosis rates in lesions with various atypical appearances andthose with none or single atypical appearance.Misdiagnosis rates in lesions with different sizes and pathological types wereanalyzed statically.Then misdiagnosing causes were analyzed.Results A total of 404 lesions were diagnosed correctly,in-cluding 99 lesions with atypical appearances,and the other 89 lesions were misdiagnosed,which showed atypical appear-ances.The misdiagnosis rate of lesions with ≥2 atypical features was higher than that with none or single atypical feature(x2 =256.40,P＜ 0.05).Large lesions (maximum diameter＞ 3 am) showed higher misdiagnosis rates than small ones(maximum diameter ≤3 cm,x2=6.73,P＜0.05),and complex fibroadenoma lesions also showed higher misdiagnosisrate than simple ones (x2 =188.01,P＜0.05).Conclusion The lesions with various atypical appearances,large size andcomplex fibroadenoma in pathology are easy to be misdiagnosed.

Objective To probe the value of gastroduodenal water window in ultrasonic diagnosis of ampulla carcinoma. Methods Sixty-three patients were divided into the conventional ultrasonic examination group(including 35 patients) and the gastroduodenal water window ultrasonic examination group(including 28 patients), all being detected before and after drinking. The results of ultrasonic examination of the groups were divided into Ⅰ, Ⅱ and Ⅲ grades. The diagnostic accurate rates and the rates of Ⅰ, Ⅱ and Ⅲ grades of the ultrasonic examination of the groups were compared respectively. Results The diagnostic accurate rate of the gastroduodenal water window group after drinking was 96.43%(27/28), which was markedly higher than that of the same group before drinking and the conventional group which were 60.71%(17/28) and 54.29%(19/35) respectively. The rates of Ⅰ, Ⅱ and Ⅲ grades of the ultrasonic examination of the gastroduodenal water window group after drinking were also markedly higher than those of the same group before drinking and the conventional group respectively (all P 0.05). Conclusions The gastroduodenal water window ultrasonic examination can effectively raise the ultrasonic diagnostic rate of ampulla carcinoma. It is of significance in the clinic.

Objective To probe the characteristics of the ultrasonography of the intrahepatic duct cystic tumor(IDCT).Methods The ultrasonography of 12 patients with IDCT was analysed.The results were compared with the operation and pathology.Two of them were intraductal papillary adenomas,six were papillary adenocarcinomas,two were biliary cystadenomas and two were biliary cystadenocarcinomas.Results The ultrasonic diagnostic rate was 75%(9/12).The bile ducts of 10 cases(83%) were cystically dilated.Seven cases(58%) with thick walls of bile ducts were all malignant.Six tumors(50%) with intraluminal papillate echoes could be malignant or benign.The tremellose echoes were detected in 7 cases(58%) and the common bile ducts of six cases were obstructed by the tremellose substance.Conclusions It is the important diagnostic basis of IDCT that the bile ducts in some liver lobal or segment are dilated without reasons,with the thick bile duct wall and the poor ultrasound penetration,especially when the bile ducts are full of tremellose substance and the papillomas are detected in the ducts.It is of significance in the clinic to raise the early diagnostic rate of IDCT by ultrasound.

Objective To investigate the value of ultrasonography in diagnosis and preoperative TNM staging for neuroendocrine breast cancer(NEBC).Methods The ultrasonic characteristics of 12 NEBC and 104 invasive ductal carcinoma(IDC) confirmed by pathology,as well as the metastatic lymph nodes were analyzed retrospectively.The TNM-staging for NEBC by preoperative ultrasonography was evaluated according to pathology.And the relation between lesions size and Ki-67 was then analyzad.Results NEBC lesions mainly showed solid and heterogeneous hypoechoic(66.67％),irregular shape(66.67％),clear border (58.33 ％),posterior enhancement(58.33 ％) and internal blood flow(grade 0-Ⅰ) (66.67 ％).The detection rate of unclear border,irregular edge,hyperechoic halos and uneven internal echo was lower than IDC(P ＜ 0.05).Meanwhile,NEBC had a lower detection rate of calcification and internal blood flow(grade Ⅱ-Ⅲ)than IDC (P ＞0.05).And the detection rate of more round or oval lesions were higher in NEBC than that in IDC (P =0.001).According to pathology,the ultrasonic coincidence rate for T staging of NEBC and pathology was 75％,and for T1-staging was 100％,for T2-staging was 80％.The sensitivity,specificity,positive predictive value and negative predictive value of ultrasonic diagnosis on lymph node metastases was 66.67％,88.89％,66.67％ and 88.89％,respectively.There was a positive correlation between focal maximum diameter with Ki-67 (r=0.026,P=0.004).Conclusions It shows certain value of ultrasonography in diagnosis and preoperative TNM staging for NEBC.

Objective To probe the ultrasonic diagnostic value in splenic lyrnphoma and classify the sonographic appearance of splenic lymphoma.Methods The clinical datas and ultrasonic appearances of 31 patients with splenic lymphoma were compared with the pathology.The ultrasonic images were classified.Results Among the 31cases,3 cases with splenic lymphoma and 5 cases with splenic infiltration of splenic lymphoma were correctly diagnosed by ultrasound.The diagnostic correct rate was 25.8%.The sonographic appearances of 31 cases were divided into four types.Homogeneous splenomegaly type(12.9%,4/31),showed homogeneous splenomegaly without mass in the spleen.Multiple nodule type(16.2%,5/31),showed multiple hypoechoic nodules diffused in the spleen.Solitary mass type(29.0%,9/31),showed solitary mass larger than 3 cm with or without necrosis in the spleen.Comples type(41.9%,13/31),showed splenomegaly,hypoechoic masses and nodulars of different sizes in the spleen.Conclusions The sonographic diagnosis of splenic lymphoma is valuable to the clinic.The ultrasound-guided splenic biopsy could be carry out if necessary.

Objective To investigate the tumor chemical ablation and analgesic effects of compound lauromacrogol,and to explore a new method for ultrasound-guided tumor ablation.Methods 18 VX2 tumorbearing rabbits were randomly divided into saline group,ethanol group and compound lauromacrogol group,and the medicine was intratumoral injected guided by ultrasonography.After 4 times treatment,tumor contrast-enhanced ultrasonography,tumor growth inhibition rate and tumor tissue pathology were performed to evaluate the antitumor effects.The analgesic effect was evaluated using the pain model induced by formaldehyde test.Results Ultrasound-guided intratumoral injection of compound lauromacrogol showed significant antitumor effects with a tumor growth inhibition rate of 63.3 ％,which was higher than that of ethanol group.No apparent enhancement was found under contrast-enhanced ultrasonography,and pathology results confirmed wide necrosis.In saline,ethanol and compound lauromacrogol groups,the average accumulated points were 62.25 ± 9.79,21.00 ± 9.13 and 9.87 ± 3.10,respectively by formaldehyde test.Conclusions Ultrasound-guided chemical ablation using compound lauromacrogol showed complete antitumor and strong analgesic effects,which would be a new method for tumor ablation.

Objective To compare the ultrasonic and mammographic appearances of breast chronic inflammation (BCI). Methods The ultrasonic and mammographic features of 20 pathologically conifrmed BCI cases were analyzed retrospectively. All cases were of single lesion. Fisher deifnite probability method was used to compare the differences between ultrasonic and mammographic appearances as well as the diagnostic coincidence rate. Results Under ultrasonography, the mean longitudinal diameter/transverse diameter (L/T) ratio of 20 lessions was calcultated as 0.47±0.15, 17 lesions were of irregular shape, unclear boundary and inhomogeneous hypoecho, 13 lesions were of posterior echo enhancement, the blood lfow of 10 lesions belonged to 0-Ⅰ, and the other 10 belonged toⅡ-Ⅲ. The lesion shape, boundary and homogeneity detected by mammography were coincident to those by ultrasonography (P=1.00, 1.00, 0.61, respectively). In 5 lesions, dotted high-echoes were detected by ultrasonography, however no calciifcation was found by mammography. Meanwhile, 1 lesion with sporadic calciifcation detected by mammography was missed by ultrasonography. Ultrasonography detected 5 cases with axillary lymphadenopathy, in which only 1 case was found by mammography. The diagnostic coincidence rate of ultrasonography was 40%(8/20), which was obviously higher than 6% (1/16) by mammography (P=0.03). Conclusion BCI possesses certain ultrasonographic characteristics, and ultrasonography combined with mammography will be helpful for the differential diagnosis of malignant and benign diseases.

Objective To investigate the sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and to decrease misdiagnosis rate. Methods Thirty-one patients with 35 FV-PTCs and 66 patients with 75 conventional PTCs (C-PTCs) were enrolled in this study. The sonographic features were reviewed retrospectively between the two groups with universally accepted standards. Results The sonographic features of 35 FV-PTCs included irregular shapes (6/35), anteroposterior to transverse diameter ratio A/T > 1 (7/35), spiculated margins (25/35), marked hypoechogenicity (0/35), hypoechogenicity (18/35), isoechogenicity (16/35), no calcification (15/35), microcalcifications (11/35), macrocalcification (9/35), color Doppler lfow patternⅠ(20/35), color Doppler lfow patternⅡ(10/35), color Doppler lfow patternⅢ(5/35). Irregular shapes, A/T>1, spiculated margins, marked hypoechogenicity, microcalciifcations, and color type Ⅱ were rarer in FV-PTCs than in C-PTCs, while isoechogenicity, no calciifcation, macrocalciifcation, and color type Ⅲwere more frequent in FV-PTCs than in C-PTCs. The differences of the above features were statistically significant [χ2=4.276, P=0.039; χ2=8.125, P=0.004; P=0.009 (Fisher′ s exact test); χ2=8.548, P=0.003;χ2=4.898, P=0.027,χ2=7.796, P=0.005;χ2=5.462, P=0.019;P=0.001 (Fisher′s exact test)] . During the preoperative ultrasonography, 20 of 35 FV-PTCs were diagnosed as malignancy, and others were misdiagnosed as benign nodules (misdiagnosis rate was 43%). The lymphatic metastasis rate of FV-PTCs was 29%(9/31), significantly lower than C-PTCs [62%(41/66),χ2=9.246, P=0.002]. In terms of the sonographic features of metastatic lymph nodes, there was no marked difference between FV-PTCs and C-PTCs. Conclusions Some FV-PTCs are lack of malignant features, and tend to be misdiagnosed frequently when coexisting with benign thyroid nodules. Observing the echogenicity, color lfow characteristics and other features of each thyroid nodule and cervical lymph node with multiple views may decrease the misdiagnosis rate.

Objective To explore the value of high frequency ultrasound in differential diagnosis in dorsal thyroid (including gland dorsal or posterior) nodules.Methods Ultrasonographic features of 101 patients with ultrasonography suspected or misdiagnosed nodules in the dorsal area of the thyroid gland,which were then confirmed by pathology or hyaluronography/gastroscopy,were retrospectively analyzed.Ultrasonographic homogeneity (other nodules with similar ultrasonographic features were found in the ipsilateral gland),parenchyma homology (nodule parenchyma was continuous with glandular parenchyma) and blood homology (blood flow signals in nodules were continuous with those in glandular parenchyma) were applied as indicators for determinng thyroid nodules.Double-line sign or vascular arch sign at the edge of nodules served as an indicator for determining parathyroid nodules.Results Of the 101 cases,there were 46 thyroid nodules,35 parathyroid nodules,7 enlarged lymph nodes;6 esophageal diverticulum,6 esophageal cancer,1 cleft cyst.The determination of thyroid nodules by at least one of ultrasonographic homogeneity,parenchyma homology and blood homology showed sensitivity of 73.5 ％,specificity of 96.5 ％ and accuracy of 85.8％.In the determination of parathyroid nodules by double-line sign or vascular arch sign at the edge of nodules,sensitivity,specificity and accuracy was 54.1％,85.5 ％ and 74.5 ％,respectively.Conclusions Nodules in the dorsal area of the thyroid gland have different sources,and the understanding of corresponding characteristic ultrasonographic appearances is helpful for improving the differential diagnosis of these nodules.